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Intercostal nerve transfer in infants with obstetric brachial plexus palsy

โœ Scribed by Tarek A. El-Gammal; Mohamed M. Abdel-Latif; Mohamed M. Kotb; Amr El-Sayed; Yasser Farouk Ragheb; Waleed Riad Saleh; Mohamed A. Geith; Hala S. Abdel-Ghaffar

Publisher
John Wiley and Sons
Year
2008
Tongue
English
Weight
167 KB
Volume
28
Category
Article
ISSN
0738-1085

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โœฆ Synopsis

Abstract

The use of intercostal nerve (ICN) transfer to repair brachial plexus lesions associated with root avulsions is a well known procedure in adults. However, there is a paucity of reports on the use of ICN in infants with obstetrical brachial plexus palsy (OBPP). This study included 46 infants with obstetric brachial plexus palsy who underwent 62 neurotization procedures. Clinically, 2 cases had upper trunk injury, 19 had upperโ€middle trunk injury, 3 had lower trunk injury, and 22 had total palsy. The average age at surgery was 14 months. Twelve patients underwent surgery younger than 6 months of age, 11 patients at 6 to <9 months, 9 patients at 9โ€“12 months, and 14 patients at >12 months. The average followโ€up period was 49 months. ICN transfer resulted in 76% satisfactory (good and excellent) outcome, and was best for restoration of elbow flexion (93.5%). Functional results were best when the operation was done before the age of 9 months; however, the difference between age groups was statistically insignificant. Functional results were also independent of the extent of the original injury. Nine children had preoperative and postoperative CT chest scans. All the nine children developed basal pulmonary atelectasis postoperatively. Pulmonary atelectasis was mostly ipsilateral and was not correlated to the patient age (months), or the duration of anesthesia (in minutes). We conclude that, intercostals nerve transfer is an effective procedure for restoration of function in infants with OBPP and root avulsions. The procedure is associated with variable degree of ipsilateral pulmonary atelectasis. ยฉ 2008 Wileyโ€Liss, Inc. Microsurgery, 2008.

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